在接受复杂穿皮冠状动脉干预的高危患者中,抗血小板治疗的时间调节:TAILORED- CHIP随机临床试验
Do-Yoon Kang1, Seong-Bong Wee1, Jung-Min Ahn1
1Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
European heart journal
|August 31, 2025
概括
在接受复杂穿皮冠状动脉干预 (PCI) 的高风险患者中,量身定制的抗血小板策略没有减少不良事件. 与标准的双重抗血小板治疗相比,该研究发现类似的缺血事件发生率,但随着量身定制的治疗,出血增加.
科学领域:
- 心脏病学
- 干预心脏病学
- 药理学
背景情况:
- 对于接受复杂皮肤冠状动脉干预 (PCI) 的高风险患者,最佳的抗血小板策略尚不清楚.
- 这项研究解决了针对该群体的针对性抗血小板治疗方案的证据需求.
研究的目的:
- 研究针对性抗血小板策略的有效性和安全性,包括对血小板抑制强度的时间调节.
- 在接受复杂PCI的患者中,将这种定制方法与标准的双重抗血小板治疗进行比较.
主要方法:
- 一项随机试验,涉及2018名接受复杂PCI的高风险患者.
- 患者被分配到一个量身定制的策略 (提前升级以tcagrelor/ aspirin,晚期降级以clopidogrel) 或标准的双重抗血小板治疗 (clopidogrel/ aspirin12个月).
- 主要结局是主要不良事件 (死亡,心脏病发作,中风,支架血栓形成,紧急再血管) 和临床相关的出血12个月后.
主要成果:
- 主要综合结局发生在量身定制治疗组的10. 5%,而双重治疗组的8. 8% (HR,1. 19;95% CI,0. 90-1. 58;P =.
- 在两组之间,主要的缺血事件相似.
- 与双重治疗组相比,量身定制治疗组的临床相关出血率较高 (7. 2%).
结论:
- 在接受复杂PCI的高风险患者中,早期升级和晚期降级的定制抗血小板策略并没有降低12个月的净不良事件发生率.
- 与标准的双重抗血小板治疗相比,量身定制的方法与数量上更高的初级事件和显著更多的出血事件有关.
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